Conectar
by Haojie Wang, Mengxiang Li, Xiaomeng Liang, Weijian Wang, Pengren Luo, Jiaji Zhang, Yuxuan Du, Tan Liu, Boyu Zhang, Xu Wang, Zhefeng Jin, Yilin Zhu, Tao Han
Background & objectivePrevious biomechanical studies on pediatric flexible flatfoot have treated the subject as a single analytical unit, thus failing to elucidate mechanical transmission within the lower extremity closed kinetic chain. This study investigates the impact of distal arch collapse on macroscopic gait parameters, static joint alignment, and dynamic kinematic deviation by integrating a dual-level analytical strategy at both the subject and individual limb levels.
Methods153 children with pediatric flexible flatfoot (25 unilateral, 128 bilateral) were included, and 3D gait data from 306 lower extremities were analyzed. At the subject level, macroscopic spatiotemporal parameters were compared using the Mann-Whitney U test. At the limb level, linear mixed-effects models (LMMs) compared static 3D joint angles and Gait Variable Scores (GVS) between normal feet and flatfeet, treating subject as a random effect and adjusting for age, body mass index (BMI), and unilateral leg length.
ResultsAt both the subject and limb levels, no significant between-group differences were observed in any core spatiotemporal parameters (e.g., Mean Velocity, Frequency, and Step Width) (P > 0.05). Regarding static joint alignment at the limb level, the static Hip Rotation angle on the flatfoot side exhibited significantly less external rotation (i.e., relative internal rotation) compared to the normal side (−2.11° ± 0.67° vs. −5.79° ± 1.79°, P = 0.043). During dynamic walking, the Hip Abduction/Adduction GVS on the flatfoot side was significantly elevated (P = 0.032). However, comprehensive gait indices, including the GDI and GPS, showed no significant overall between-group differences.
ConclusionPediatric flexible flatfoot was associated with subtle proximal biomechanical alterations despite preserved macroscopic gait characteristics. Changes in static hip alignment and dynamic frontal-plane hip kinematics may therefore provide complementary information beyond conventional gait measures, supporting a broader kinetic-chain assessment in clinical evaluation and follow-up.
IgG4-related disease is a chronic fibroinflammatory disease with multiorgan involvement. Glucocorticoids and/or immunosuppressants as well as rituximab are both first-line treatments in remission induction therapy. However, relapse is common during the maintenance period, particularly in patients with re-elevation of serum IgG4 level. This study aims to evaluate whether adding mycophenolate mofetil (MMF) during the maintenance phase for such patients can reduce the risk of disease flare.
This study is a multicentre, randomised, double-blind, placebo-controlled study. A total of 108 eligible patients with re-elevation of serum IgG4 level during maintenance therapy will be included in this study and randomised in a 1:1 ratio to receive add-on MMF 0.5 g one time per day or placebo for 52 weeks. The primary outcome is the proportion of patients experiencing relapse at week 52. Secondary outcomes include time-to-relapse, changes in disease activity and serum IgG4 level, stratified relapse rate according to the elevation level of IgG4. Analyses will follow the intention-to-treat principle.
The study has been approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (approval no. K3231). Written informed consent will be obtained from all participants before enrolment. Findings will be disseminated through peer-reviewed journals and conference presentations.
Artificial intelligence-based conversational agents (CAs) have shown transformative potential in healthcare, yet their application in cancer health education has remained underexplored, particularly regarding usability and patients' experiences. Existing reviews lack a dedicated focus on user perspectives, limiting insights into how CAs can be optimised for patient needs.
To explore the usability and experience of artificial intelligence-based conversational agents in health education for cancer from the user perspective.
A scoping review was conducted with the Joanna Briggs Institute Scoping Reviews conduct guidance and reported according to the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist.
A search was performed in PubMed, Embase, CINAHL, Web of Science, PsycINFO, IEEE Xplore Digital Library and ACM Digital Library from their inception to March 6, 2024. The references to the articles included were also searched. The Pillar Integration Process was employed to chart data.
A total of 12 studies were included in this scoping review, which revealed that CAs supported diverse educational contexts, including cancer-related knowledge (41.7%), pretest genetics (33.3%), self-management (16.7%) and psychological skills (8.3%). Three studies reported that patients preferred interactions with multiple options or ‘read more’ functions. Patients were generally optimistic about the CAs and reported that CAs provided informational, physical, and psychological support for them. However, limitations such as insufficient customisation, lack of empathy, and defects in understanding free-input questions were noted.
This review demonstrated that CAs are promising complementary tools in cancer education, alleviating healthcare burdens while enhancing patient engagement, which was particularly critical in resource-limited settings. However, clinical implementation requires more rigorous validation of safety protocols and high-quality original studies.
Nurses and policymakers should consider CAs valuable tools to enhance cancer health education, provided that they align with patient needs and institutional safety standards.
Ample evidence has shown the benefit of high-fidelity simulation (HFS) in promoting learning in pre-licensure nursing students, but the evidence for practising registered nurses has not been synthesised.
To evaluate the effects of HFS training on learning outcomes and satisfaction in practising registered nurses.
In this systematic review and meta-analysis, we searched PubMed, CINAHL, ERIC, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for studies published in English or Chinese from database inception to 31 May 2023 (updated on 20 April 2025). All randomised controlled trials (RCT) or quasi-experiments that compared HFS training with traditional methods (e.g., lecture) for practising registered nurses and reported learning outcomes and satisfaction were included. Risk of bias was assessed by the Cochrane risk-of-bias tool for randomised trials (RoB 2) and non-randomised trials (ROBINS-I). Inverse-variance random-effect models were used to calculate standardised mean differences (SMDs) with 95% confidence interval (CI). We followed the PRISMA 2020 guideline.
Of 1404 records, eight eligible studies (five RCTs and three quasi-experiments) involving 275 practising nurses were identified. Two RCTs had high risk of bias, while others showed some concerns or moderate risk of bias. Meta-analyses showed that HFS could promote knowledge acquisition (SMD = 0.65, 95% CI, [0.35, 0.95], p < 0.01, I2 = 0%), professional skills (SMD = 0.72, 95% CI, [0.41, 1.04], p < 0.01, I2 = 0%) and learning satisfaction (SMD = 1.24, 95% CI, [0.35, 2.13], p < 0.01; I2 = 67%), compared with traditional methods. The pooled effect on self-confidence was marginally insignificant (SMD = 0.59, 95% CI, [−0.04, 1.22], p = 0.07; I2 = 67%).
Compared with traditional training methods, HFS is effective in promoting knowledge acquisition, professional skills and learning satisfaction and may enhance self-confidence among practising nurses. To strengthen the evidence base, more rigorous RCTs with larger sample sizes, adequate reporting of HFS design, and standardised outcome measures are warranted.
PROSPERO (CRD42022358717). No Patient or Public Contribution.
by Chunxiao Liu, Yanhua Wang, Qiuxia Liu, Sha Zhang
Liposarcoma (LPS) is a common soft tissue sarcoma; however, its molecular pathogenesis and immune cell infiltration remain poorly understood. This study investigated potential driver genes and pathways in LPS and characterized immune cell infiltration patterns to identify potential markers for targeted therapy. Differentially expressed genes (DEGs) in LPS were analyzed by GO and KEGG pathway enrichment analysis. A protein-protein interaction network was constructed using the STRING database and visualized with Cytoscape. mRNA expression of genes with high |logFC| values was verified by RT-qPCR. Immune cell subsets were quantified using CIBERSORT. GO and KEGG analysis revealed significant functional clusters and pathways, and most verified genes were consistent with the bioinformatics analysis. Survival analysis showed that high expression of TYMS, KIF20A, BUB1B, LMNB1, RRM2, ZWINT, and RACGAP1 was significantly associated with poor overall survival and poor disease-free survival (DFS). High levels of TMSB15A, TPX2, PKM2, and PTTG1 were significantly associated with poor DFS alone. CIBERSORT analysis identified a significantly higher fraction of resting mast cells (MCs) in LPS tissues compared to normal fatty tissues (P < 0.05). TOP2A, IL-6, PCNA, CDK1, JUN, MYC, CCNB1, EGFR, ACACB, and BIRC5 were identified as potential diagnostic biomarkers of LPS, providing strong evidence for hub gene studies. Immune cell infiltration analysis further suggested that resting MCs may play a potential role in LPS development, although further experimental validation is warranted. Collectively, these findings clarify the molecular basis of LPS and provide a foundation for future research into its treatment.The optimal timing for direct oral anticoagulants (DOACs) initiation after acute ischaemic stroke in patients with atrial fibrillation (AF) remains unclear, particularly in those undergoing endovascular thrombectomy (EVT), who are at higher risk of both haemorrhagic transformation and early embolic recurrence. Patients undergoing thrombectomy have been under-represented in previous randomised trials, resulting in limited evidence for guiding management in this high-risk population. The TIMERS trial aims to evaluate the efficacy and safety of early versus delayed initiation of DOACs therapy after EVT in patients with large vessel occlusion stroke and AF.
This is a multicentre, prospective, randomised, open-label trial with a blinded outcome assessment. In total, 438 patients with acute ischaemic stroke and AF treated with EVT will be enrolled in this study. Patients will be randomised in a 1:1 ratio within 72 hours after stroke onset to early initiation (≤4 days) or delayed initiation (5–14 days). The primary outcome is a composite of recurrent ischaemic stroke, symptomatic intracranial haemorrhage or all-cause death within 90 days. Secondary outcomes include individual components of the primary endpoint, venous thromboembolism, systemic embolism, myocardial infarction, functional outcome (modified Rankin Scale), health-related quality of life (EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L)) and major extracranial bleeding events.
The study is approved by the Ethics Committee of Xuanwu Hospital of Capital Medical University, the ethics approval document number is (2025)259-001. The trial findings will be disseminated through peer-reviewed publications and presentations at scientific conferences.
Preoperative anxiety in children is a common problem in paediatric surgical care. In current practice, anxiety is assessed mainly by behavioural rating scales, of which the modified Yale Preoperative Anxiety Scale (mYPAS) is the most widely used. However, behavioural observation may not capture children whose outward behaviour stays calm while their autonomic stress response is still high. This mismatch between visible behaviour and underlying physiology can lead to under-recognition of anxiety and may explain the modest correlations reported between behavioural scores and physiological markers in children. The aim of this scoping review is to map the published evidence on physiological–behavioural discordance during paediatric perioperative anxiety and to identify methodological gaps that future multimodal assessment research will need to address.
The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews reporting guideline and the Joanna Briggs Institute methodology for scoping reviews. We will search PubMed/MEDLINE, Embase, Web of Science Core Collection, CINAHL Complete and PsycINFO from database inception to 31 December 2025. Eligible studies will recruit children aged 0 to 18 years in perioperative or analogous procedural settings, and will report both a behavioural anxiety measure (such as mYPAS, mYPAS-SF, State–Trait Anxiety Inventory for Children (STAI-C)) and at least one concurrent physiological stress indicator (heart rate variability, salivary cortisol, salivary alpha-amylase, electrodermal activity, heart rate or intraoperative nociception indices). The primary analysis will focus on perioperative anaesthesia induction. Procedural sedation, venipuncture and dental contexts will be analysed as a separate secondary stratum because their stress profile is not the same as anaesthesia induction. Two reviewers will screen and extract data independently. Premedication exposure, regular home psychoactive medication use (including cannabinoids) and the time gap between behavioural and physiological sampling will be extracted as prespecified confounders. Findings will be synthesised narratively following the Synthesis Without Meta-analysis reporting guideline.
Ethical approval is not required because the review uses only published literature. Results will be submitted to a peer-reviewed journal and presented at paediatric anaesthesia conferences. A plain-language summary will be co-produced with parent advisors.
Intravenous thrombolysis is the standard early treatment for acute ischaemic stroke (AIS), yet a substantial proportion of patients, particularly those with mild disabling deficits, do not achieve favourable functional recovery. Tenecteplase (TNK), a fibrin-specific thrombolytic agent administered as a single bolus, and butylphthalide (NBP), a multi-mechanism neuroprotective agent, have each shown benefit in AIS. However, whether their combination confers additional benefit in mild disabling AIS remains unknown. This trial aims to determine whether adding NBP to TNK improves functional outcomes in patients with mild disabling ischaemic stroke treated within 4.5 hours of symptom onset.
BENEFIT-2 is a prospective, multicentre, randomised, double-blind, active-controlled trial. Eligible patients will be randomised 1:1 to receive either TNK plus NBP (combination group) or TNK plus placebo (control group) via block randomisation. The intervention comprises intravenous NBP 25 mg/100 mL two times per day for 7 days, followed by oral NBP 0.2 g three times per day up to day 14, with matching placebos for the control group. Key eligibility criteria include age 18–80 years, symptom onset within 4.5 hours, baseline National Institutes of Health Stroke Scale (NIHSS) score 2–5 with persistent unilateral weakness or speech impairment, and prestroke modified Rankin Scale (mRS) score 0 or 1. The primary outcome is the proportion of patients achieving mRS 0–1 at 90 days (allowable window ±7 days). Secondary endpoints include change in NIHSS, stroke recurrence, major vascular events, quality of life measured by EQ-5D and penumbral salvage on imaging. Safety endpoints comprise symptomatic intracranial haemorrhage, vascular death, all-cause mortality and other adverse events within 90 days. The primary analysis will follow the intention-to-treat principle.
Ethics approval has been obtained from the Independent Ethics Committee of Xiangya Hospital (No. 2026020399), Central South University. Results will be published in peer-reviewed journals and presented at academic conferences.
Dietary modification is an important strategy for the prevention of type 2 diabetes, with fibre intake recognised as a key factor in promoting metabolic health. Resistant starch (RS), a type of fermentable dietary fibre, has emerged as a promising therapeutic approach due to its association with weight loss, enhanced insulin sensitivity and improved glucose metabolism. As nutritional research progresses, the focus has shifted from individual nutrients to overall dietary patterns. Based on this concept, this study aims to investigate the metabolic effects of a dietary pattern that optimises carbohydrate structure by increasing RS intake and reducing rapidly digestible carbohydrate in adults with pre-diabetes.
This is a multicentre, randomised, parallel-controlled clinical trial, which will enrol 250 adults diagnosed with pre-diabetes. Eligible participants will undergo randomisation to receive either a guideline-based conventional diet or an optimised carbohydrate diet (OCD). In the OCD intervention, daily RS intake will be increased to approximately 40 g, with fibre intake rising to 20–40 g per 1000 kcal. At the same time, the intake of rapidly digestible starch and free sugars will be reduced. The intervention will last for 6 months, followed by a 3-month post-intervention follow-up period. The primary outcome is the change in postprandial glycaemic response, assessed using the incremental area under the curve (iAUC) for plasma glucose during the oral glucose tolerance test (OGTT). Secondary outcomes include the proportion of participants achieving remission to normoglycaemia or progressing to type 2 diabetes, changes in other glucose- and lipid-related metabolic parameters and changes in lifestyle-related behavioural factors. Exploratory outcomes will include changes in appetite-related hormones, circulating cytokines, immune function and multi-omics profiles.
This study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Approval No. 2025-122; Protocol V.1.0, 20250811) and the Ethics Committee of Shenzhen Center for Chronic Disease Control (Approval No. SZCCC-2024-011-01-PJ) and registered in the Chinese Clinical Trial Registry. Findings from this study will be disseminated in peer-reviewed journal publications.
ChiCTR2500113583.
by Tian-Qi Li, Qin Zhang, Hui-Juan Wang, Zhao-Feng Ma, Bing-Yu Lu, Ke-Gui Hou, Xiang-Yu Zhang
ObjectiveTo detect and analyze the correlation between commonly mutated genes and known genes associated with tooth agenesis in patients with non-syndromic tooth agenesis. The aim is to explore new genes that may be associated with tooth agenesis, to provide a genetic reference for its prevention as well as for the clinical diagnosis and treatment of tooth agenesis.
MethodsGenomic DNA was extracted from the peripheral blood of 18 congenitally edentulous subjects, and related gene mutations were identified by whole-exome sequencing. The genes related to maxillofacial development and the known pathogenic gene sequences of congenital tooth agenesis were selected for local alignment analysis of pairwise sequences, and the metric relationship of related sequences was determined. Hierarchical and fuzzy clustering methods were used for cluster analysis.
ResultsHierarchical clustering and fuzzy clusterings yielded consistent results. The EPB41L4A gene clustered with a large number of well-known and well-defined genes associated with tooth agenesis. From the perspective of cluster analysis, it can be inferred that the genes clustered together generally have similar functions.
ConclusionEPB41L4A, which is involved in the Wnt pathway, may be a candidate gene warranting further investigation.
by Tianyu Zhang, Yu Yuan, Chunli Lin, Chao Song, Tianrong Liao, Yuewen Sun, Hongzhen Tang
BackgroundPerfluorooctanoic acid (PFOA), a pervasive environmental pollutant, has been implicated in hepatic injury and metabolic dysfunction. However, its role as an environmental risk factor in the pathogenesis of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) remains incompletely understood, particularly from a systems biology perspective.
MethodsThis study employed an integrative approach combining computational toxicology, multi-omics data analysis, and machine learning. Public databases were utilized to identify PFOA-related targets and MASLD-associated genes. A comprehensive machine learning framework comprising 113 model combinations was applied to transcriptomic datasets (GSE66676, GSE89632, GSE164760) to identify hub genes. Single-cell RNA sequencing (scRNA-seq) analysis delineated cell type-specific expression patterns. Molecular docking and dynamics simulations assessed the binding stability between PFOA and core targets, which was further validated in vitro using an FFA-induced MASLD HepG2 cell model.
ResultsWe identified 17 shared targets between PFOA and NAFLD. Machine learning pinpointed six hub genes (NR4A2, BCL6, CASP1, SHBG, FABP4, IL10) with high diagnostic accuracy (AUC up to 0.996). scRNA-seq revealed distinct expression patterns of these genes across liver cell subtypes in MASLD. Molecular docking and dynamics simulations demonstrated stable binding of PFOA to SHBG and FABP4. In vitro experiments confirmed that PFOA exposure significantly altered the mRNA and protein expression levels of these core genes in the MASLD model.
ConclusionOur findings suggest a potential mechanistic association between PFOA exposure and MASLD pathogenesis, characterized by disruption of lipid metabolism, inflammatory responses, and immune homeostasis. While these results identify biologically plausible pathways, they do not establish epidemiological causation, and further prospective studies with quantified PFOA exposure are required to confirm causality in humans.
The treatment of bladder cancer often involves radical cystectomy and urostomy, which increase survival rates but cause significant physical, psychological and social distress. While existing evidence emphasizes treatment and interventions to improve the quality of life, few studies have explored the continuous health management experience and needs of urostomy patients from diagnosis through recovery.
To construct a journey map of the healthcare management needs of urostomy patients to explore key pain points in their rehabilitation process and provide a reference for continuous health management.
A descriptive qualitative study was conducted. Using purposive sampling, 25 participants who underwent urostomies were recruited from a tertiary hospital in Tianjin, China. Data were collected through semi-structured face-to-face in-depth interviews. Conventional content analysis was used to analyse the data, extract themes and visualize dynamic changes in patient needs via a patient journey map.
The patient journey map delineated four phases and extracted 12 themes. During the screening and diagnosis phases, participants experience symptom distress, information overload and fear of recurrence. The perioperative phase was marked by challenges in symptom management, frustration in learning stoma skills and abrupt transitions in caregiving models. During the transitional adaptation and continuing treatment phases, participants experience survival fatigue due to the dual burden of early complications, chemotherapy reactions and financial pressure. In the long-term self-management phase, participants struggle with cumbersome self-management routines, anxiety about recurrence and barriers to psychosexual and social reintegration. Fortunately, some participants show posttraumatic growth and resilience after urostomy.
The rehabilitation of urostomy patients is a complex process accompanied by information overload, shifts in caregiving and the superimposition of physical and psychological symptoms. Healthcare professionals should prioritize these multidimensional needs across stages, establish an intelligent continuous care platform led by ostomy specialist nurses and be supported by multidisciplinary collaboration.
Healthcare professionals should establish an intelligent, continuous care platform led by ostomy specialist nurses to monitor home-based rehabilitation. The implementation of staged multimodal health education across all disease phases is crucial. Furthermore, clinical practice must actively provide psychosexual counselling, support social reintegration and deliver targeted interventions to alleviate the immense psychological burden on family caregivers.
This study followed the COREQ guidelines for reporting qualitative studies.
No patient or public contribution.
by Rili Yu, Xia Yang, Juan Chen, Fan Zhang
BackgroundPostoperative nausea and vomiting (PONV) is a common and distressing complication following shoulder arthroscopy. Although hypotension is known to trigger nausea, the specific association between sustained intraoperative hypotension (SIH) during shoulder arthroscopic surgery and PONV has not been well characterized. This retrospective study aimed to investigate whether SIH is independently associated with PONV.
MethodsWe retrospectively analyzed data from 306 patients who underwent shoulder arthroscopy between March 2018 and January 2024. SIH was defined as a ≥ 20% decrease in mean arterial pressure (MAP) from baseline persisting for at least 60 minutes during the controlled hypotension phase. Univariate logistic regression analysis and multivariate exact logistic regression analysis were performed to identify factors associated with the occurrence of PONV. PONV severity was compared between the SIH and non-SIH groups using the chi-square test.
ResultsPONV occurred in 96 patients (31.37%). Univariate logistic regression analysis revealed that females, smoking, history of motion sickness and/or PONV, and SIH were related to the occurrence of PONV (all p < 0.05). Multivariate logistic regression analysis revealed that females (adjusted OR: 3.966, 95% CI: 2.149–7.317, p < 0.001), smoking (adjusted OR: 0.232, 95% CI: 0.107–0.501, p < 0.001), history of motion sickness and/or PONV (adjusted OR: 32.393, 95% CI: 3.801–276.051, p = 0.001), and SIH (adjusted OR: 2.198, 95% CI: 1.289–3.749, p = 0.004) were independently associated with the occurrence of PONV. Additionally, patients with SIH exhibited significantly higher severity grades for both nausea (p = 0.002) and vomiting (p = 0.007).
ConclusionSIH due to controlled hypotension during shoulder arthroscopic surgery was independently associated with PONV. SIH may serve as a clinically relevant predictor for PONV.
Clinical reasoning is an essential competency for all physicians, and fostering this skill in medical students is a primary objective of medical education. Currently, clinical reasoning is predominantly cultivated through experiences in clinical settings; however, this approach presents certain limitations. The emergence of innovative medical simulation teaching methods has led to the increasing utilisation of standardised patient (SP) simulations in medical education. However, the specific contribution of the SP teaching method to the development of clinical reasoning skills in medical students remains unclear. Therefore, we propose a systematic review to summarise the impact of the SP teaching method on the clinical reasoning competence of medical students.
This systematic review protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines for reporting results. A comprehensive literature search will be conducted across five major online databases: PubMed, Embase, Web of Science, Education Research Complete and the Cochrane Library. The screening process comprises an initial review of titles and abstracts to identify relevant studies efficiently, followed by a full-text assessment of the selected articles. Two reviewers will independently conduct study selection, data extraction and risk of bias assessment. Data extraction will be performed using a standardised form. The primary outcome is clinical reasoning competence, and secondary outcomes are communication skills and student satisfaction. The risk of bias in included studies will be evaluated using the Cochrane Risk of Bias tool 2. Depending on the literature search results and the characteristics of the selected studies, a meta-analysis will be conducted where feasible. Otherwise, a narrative synthesis will be performed.
This study presents a protocol for a systematic review and does not involve human subjects. The findings will be disseminated through publication as a manuscript submitted to a peer-reviewed journal.
CRD420251163882.
Older Chinese adults in the UK face unique needs when engaging in physical activity (PA), yet culturally appropriate strategies to promote PA remain limited.
To develop culturally appropriate PA promotion strategies for older Chinese adults living in the UK.
The intervention development comprised two stages: design and optimisation. It was informed by previous research findings and input from public and community involvement and engagement. Stage 1 combined the person-based approach (PBA), which involved developing guiding principles, an intervention planning table and a logic model, with seven steps of the Behaviour Change Wheel (BCW) to identify intervention functions, behaviour change techniques (BCTs) and delivery modes to enhance older Chinese adults’ capability, opportunity and motivation for PA. Stage 2 used think-aloud interviews with 10 older Chinese adults to optimise the intervention.
Six intervention functions (education, persuasion, incentivisation, training, modelling and enablement), 27 BCTs and multiple delivery modes were identified in stage 1. In stage 2, based on think-aloud interviews with 10 participants, three prototypes were retained in their original form, one new element was added and three were removed. The remaining components were retained with either minor or major modifications. The final strategies included culturally tailored PA booklets, monthly workshops and social media support groups.
By integrating evidence, theory and stakeholder perspectives, and by combining the PBA with the BCW, this study developed the first culturally appropriate PA promotion strategies for older Chinese adults in the UK. Further research is needed to evaluate their feasibility, acceptability and effectiveness.
To compare the diagnostic accuracy of diagnostic predictors of successful weaning in mechanically ventilated adults using network meta-analysis.
Timely liberation from mechanical ventilation is linked to patient outcomes, but the comparative performance of available predictors remains unclear.
A systematic review and network meta-analysis.
We searched PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science from inception to April 8, 2026. Eligible diagnostic accuracy studies evaluated predictors of successful weaning in mechanically ventilated adults. The reference standard was successful liberation or extubation without reintubation or reinstitution of invasive ventilatory support within the study-defined window, most commonly 48 h. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Twenty-seven studies involving 2938 participants were included in the network meta-analysis and evaluated eight predictors. Four additional eligible studies were not synthesised quantitatively because each evaluated a predictor reported in only one study. The extubation predictive score (ExPreS) was excluded from the connected network because it was evaluated in two single-method studies without head-to-head comparisons, leaving seven predictors. Diaphragmatic excursion, diaphragm thickening fraction, and rapid shallow breathing index formed the core evidence network, and no significant threshold effect was detected. The network meta-analysis showed no clear statistical superiority of any single predictor. Surface under the cumulative ranking curve (SUCRA) rankings suggested that mechanical ventilation duration and diaphragmatic excursion tended to rank higher for overall discrimination and specificity, whereas rapid shallow breathing index and negative inspiratory force ranked higher for sensitivity.
Current evidence does not support a single universally optimal predictor. Diaphragmatic excursion showed a relatively balanced diagnostic profile, but this should be interpreted as a comparative signal rather than definitive superiority because certainty was generally low or very low. Weaning decisions should rely on comprehensive clinical assessment rather than any single index alone.
What problem did the study address? Clinicians caring for mechanically ventilated adults have multiple candidate predictors of weaning success, but their comparative diagnostic accuracy has remained uncertain, making bedside weaning decisions variable and potentially inconsistent.
What were the main findings? Across 27 studies involving 2938 participants included in the network meta-analysis, no single predictor showed clear statistical superiority across all comparisons. Diaphragmatic excursion showed a relatively balanced diagnostic profile, whereas rapid shallow breathing index and negative inspiratory force ranked higher for sensitivity and mechanical ventilation duration ranked higher for overall discrimination and specificity; however, the certainty of evidence was generally low or very low.
Where and on whom will the research have an impact? The findings are most relevant to critical care nurses, intensivists, respiratory therapists and multidisciplinary intensive care unit (ICU) teams caring for mechanically ventilated adults. They support a multidimensional weaning assessment strategy and may improve the safety and consistency of liberation decisions in adult critical care settings.
The findings suggest that no single index should be used in isolation to guide weaning decisions. Diaphragmatic excursion may be a useful adjunct because of its relatively balanced diagnostic profile, but bedside decisions should continue to integrate ultrasound-based measures, conventional respiratory indices, spontaneous breathing trial performance and overall clinical assessment to support safer, more individualised patient care.
This manuscript adhered to relevant Enhancing the QUAlity and Transparency Of health Research (EQUATOR) reporting guidance, specifically the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses incorporating Network Meta-analyses.
Patients, service users, caregivers or members of the public were not involved in the design, conduct, analysis, interpretation or manuscript preparation for this systematic review and network meta-analysis.
The protocol for this systematic review was prospectively registered in PROSPERO (registration number CRD420261362977). Because this study was a systematic review and network meta-analysis rather than a clinical trial, trial registration was not applicable
To explore the association between fluid balance and the occurrence of pressure injury in patients with sepsis during ICU stay.
Retrospective cohort study.
Patients were categorised based on cumulative fluid balance percentage: fluid negative balance (< 0%), neutral fluid balance (≥ 0% and ≤ 10%), and fluid overload (> 10%). Cox proportional hazard regression models were used to assess the associations between fluid balance and pressure injury occurrence.
A total of 10,669 patients with sepsis were included, 2346 (22.0%) developed pressure injuries. Patients with pressure injury had higher cumulative fluid balance within the first 3 days. In multivariable models, fluid overload on Days 1, 2, and 3 after admission was independently associated with a higher hazard of pressure injury occurrence during ICU stay, with hazard ratios of 1.30, 1.30, and 1.39, respectively.
Fluid overload occurs in 21.7% of patients with sepsis by day 3 of ICU admission and is independently associated with a higher hazard of pressure injury occurrence.
Integrating fluid management into nursing practice may support earlier identification and prevention of pressure injuries in the ICU.
This study examines the association between cumulative fluid balance and pressure injury occurrence in patients with sepsis during ICU stay. The findings may inform ICU nursing practice and pressure injury prevention strategies.
Following STROBE guideline:
This study utilised data from the Medical Information Mart for Intensive Care-IV 3.0 database.
This retrospective study used the publicly available database and did not require trial registration.
To compare the effectiveness of different intervention strategies for improving self-care maintenance, self-care management and self-care confidence in adults with heart failure.
Systematic review and network meta-analysis.
Following PRISMA-NMA guidelines, randomised controlled trials evaluating heart failure self-care interventions were included. Self-care was assessed using the Self-Care of Heart Failure Index across the eligible studies. Interventions were classified as knowledge/cognition-oriented, skill/behaviour-oriented, monitoring/feedback-reinforcement, motivation/empowerment-oriented or multicomponent. Risk of bias was assessed with RoB 2. Pairwise meta-analyses and exploratory network meta-analyses were performed.
PubMed, Embase, Scopus, Web of Science, CENTRAL, CINAHL and PsycINFO were searched from inception to March 2025.
Fifty-four trials involving 6508 participants were included, of which 32 contributed to the meta-analysis. In pairwise meta-analysis, motivation/empowerment-oriented and skill/behaviour-oriented interventions improved self-care maintenance, whereas knowledge/cognition-oriented, monitoring/feedback-reinforcement and motivation/empowerment-oriented interventions improved self-care management. Multicomponent interventions improved maintenance, management and confidence, but were not clearly superior to more focused strategies. Subgroup analyses suggested greater benefits from personalised provider feedback than from predominantly automated feedback. Exploratory network meta-analysis showed similar patterns, although rankings should be interpreted cautiously because the network was star-shaped and lacked direct comparisons between active interventions.
Heart failure self-care interventions are not equally effective across domains. Motivation/empowerment-oriented approaches showed the clearest signal for self-care maintenance, whereas knowledge-based and personalised monitoring/feedback strategies appeared more relevant for self-care management. These findings support a more targeted approach to intervention design.
Healthcare professionals should tailor strategies to specific self-care goals, prioritising motivational techniques for maintenance, structured education and monitoring with personalised feedback for management.
No patient or public involvement.
CRD420250652676
FreshRSS 